Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes the criteria by which
CCS accepts clients for service.
(1) Conditions of eligibility for Crippled
Children's Service (CCS) services include:
(A) A client must be under twenty-one (21)
years of age. All expenditures by CCS on behalf of a child must be for services
received prior to his/her twenty-first birthday;
(B) A client must be a resident of
Missouri;
(C) A client must be
financially eligible for CCS;
(D) A
client must be medically eligible for CCS;
(E) Marital status is not a condition of
eligibility; and
(F) Each client
shall have a parent or an appointed guardian as a condition of eligibility,
unless the client is legally emancipated and may sign on his/her own
behalf.
(2) To qualify
medically for services under the auspices of CCS, a client must meet the
definition of a physically-handicapped child in
19
CSR 40-1.010(16) and have a medical
condition which is included in
19 CSR
40-1.030.
(A) The
following factors shall be considered in establishing categories of conditions
eligible under CCS: severity; complexity; extent of significant dysfunction or
disability that is present or expected; duration of the disorder; potential for
habilitation or rehabilitation and also a reasonable expected longevity;
amenability to limited standard medical intervention; and a strong likelihood
the treatment will have a major impact upon the physically handicapping
condition(s). There must be reasonable expectation or improvement to be
eligible for CCS coverage.
(B) CCS
may assist any child under twenty-one (21) years of age who resides in Missouri
in obtaining a diagnostic evaluation if that child is possibly afflicted with a
CCS-eligible condition.
(C) The
medically-eligible client will be treated only for the eligible condition and
for directly related conditions necessary to prepare the client for treatment
of the eligible condition and to preserve the benefits derived from the
treatment. An unrelated medical condition which is ineligible does not become
eligible when the client is accepted for treatment of an eligible
condition.
(D) On emergency cases
that need to be referred to CCS but not previously known to the agency, it will
be the responsibility of the attending physician or the hospital to contact CCS
within seventy-two (72) hours for tentative oral approval for treatment at an
approved CCS hospital. Final approval will be given only upon receipt of an
official CCS application form and the medical report for establishing
eligibility. The application process must be initiated no later than seven (7)
calendar days after the time of admission.
(E) The client's medical condition shall be
reviewed on a periodic basis by CCS to insure the continuing CCS
eligibility.
(3) To
receive medical or surgical services, the client must be medically eligible and
the client's family must meet the current financial eligibility criteria which
are included in
19 CSR
40-1.040. An applicant shall agree to participate in
any cost-sharing that may be required.
(A)
CCS is the last resource after all other available sources of payment have been
exhausted.
(B) The financial
situation of the client and of his/her family shall be reviewed on a periodic
basis by CCS to insure the continuing CCS eligibility.
*Original authority: 192.005, RSMo 1985 and 201.060, RSMo
1959.
